• Eleven new radiotherapy networks to be operating by April, each with a lead provider
  • NHS England says new radiotherapy service specifications “may be very challenging”
  • Royal College of Radiologists warns networks will “be impossible to realise without strategic funding”

Consolidation of radiotherapy services “will be impossible” without more money, a royal college has warned.

The Royal College of Radiologists said the benefits NHS England hopes to achieve by reorganising services into 11 regional networks from April will require “strategic funding”.

The reorganisation is intended to link-up cancer centres and led to “substantially improved outcomes, including higher cure rates”. NHS England published the service specification this month.

The members of each network have already been agreed and the document said each will have a single lead provider that will be “contractually accountable to NHS England” for delivering the new service specification.

It is understood the lead provider will be chosen through mutual agreement within the network and not through a competitive tender process. 

Although NHS England said each lead will be in place by February, HSJ was told there are concerns among trusts that the networks will struggle to meet this deadline.

Due to the financial risks and governance involved in taking on the contract, the larger providers in each network are likely to be awarded the role but it is unclear what happens if trusts cannot agree. Each network will also have to elect a chair.

The tight timeline for implementation comes after NHS England took a year to publish the service specification after an earlier consultation on it closed.

Significant concerns have also been raised about how the reconfiguration will be funded.

In its response to a consultation on the new arrangements, NHS England said:”[It has] committed to providing additional resources over a three-year period to support networks to establish.” It is not clear how much this funding will be but NHSE said it will be “tied to the delivery” of agreed regional yearly plans, which are due to be published in June.

There are also major concerns about how new IT systems, which will be needed to help link up the regional networks, will be paid for.

Jeanette Dickson, RCR vice-president of clinical oncology, said: “Better IT underpins everything needed for the networks to operate but no clear funding has been earmarked. Cancer centres are charged with delivering workforce and IT solutions themselves, which we know, with all the constraints on hospital finances and existing staff shortages, is going to be next to impossible for them to do.

“It is dangerous to assume improved connectivity can occur without centralised investment, or that local workforce solutions can be achieved without a significant boost to the number of oncologists, radiographers and medical physicists who deliver the treatment.” 

NHS England said in its consultation response: “It is acknowledged that, in some areas, networks may need to invest in IT infrastructure to reap all the benefits of greater partnership working. NHS England is committed to supporting networks [to] achieve this.”

New service demands

The new service specification said each network must implement out of hours arrangements for people requiring urgent treatment, replace equipment once it is 10 years old and ensure at least 9,000 attendances per year at each provider.

Three additional requirements around the number of cases each oncologist and/or provider must handle every year have also been included in the service specification. The document said these “may take time to fulfil and may be very challenging to meet in geographically remote areas.

“It is recognised that it is important to strike the right balance between supporting local access for service users and ensuring access to specialist expertise.”

Although the networks will be “formally established and operational” by April 2019, NHS England said they will be given “two to three years” to meet the service specification.

NHS England commissions all radiotherapy activity in England as part of its specialised commissioning programme.

The table below lists the trusts involved in each network and the cancer alliances that have been assigned to each network.

Trusts involved in each networkCancer alliance/s assigned to network
Network 1  
Brighton and Sussex University Hospitals Trust Surrey and Sussex
Imperial College Healthcare Trust North West and South West London
Royal Surrey County Hospital Foundation Trust  
The Royal Marsden Foundation Trust  
Network 2  
Barking, Havering and Redbridge University Hospitals Trust  North Central and North East London
Barts Health Trust  
East and North Hertfordshire Trust  
North Middlesex University Hospital Trust  
Royal Free London Foundation Trust  
University College London Hospitals Foundation Trust  
Network 3  
Guy’s and St Thomas’ Foundation Trust South East London
Maidstone and Tunbridge Wells Trust Kent and Medway
Network 4  
Gloucestershire Hospitals Foundation Trust Peninsula
Plymouth Hospitals Trust Somerset, Wiltshire, Avon and Gloucestershire
Royal Devon and Exeter Foundation Trust  
Royal United Hospitals Bath Foundation Trust  
Royal Cornwall Hospitals Trust  
Taunton and Somerset Foundation Trust  
Torbay and South Devon Foundation Trust  
University Hospitals Bristol Foundation Trust  
Network 5  
Hampshire Hospitals Foundation Trust Thames Valley
Oxford University Hospitals Foundation Trust Wessex
Royal Berkshire Foundation Trust  
Poole Hospital Foundation Trust  
Portsmouth Hospitals Trust University Hospital  
Southampton Foundation Trust  
Network 6  
Cambridge University Hospitals Foundation Trust East of England
North West Anglia Trust  
Colchester Hospital University Foundation Trust  
Ipswich Hospital Trust  
Norfolk and Norwich University Hospitals Foundation Trust  
Southend University Hospital NHS Foundation Trust  
Network 7  
Derby Teaching Hospitals Foundation Trust East Midlands
Northampton General Hospital Trust  
Nottingham University Hospitals Trust  
United Lincolnshire Hospitals Trust  
University Hospitals of Leicester Trust  
Network 8  
Royal Wolverhampton Hospitals Trust West Midlands
Shrewsbury and Telford Hospital Trust  
University Hospitals Birmingham Foundation Trust  
University Hospitals Coventry and Warwickshire Trust  
University Hospitals of North Midlands Trust  
Worcestershire Acute Hospitals Trust  
Network 9  
Lancashire Teaching Hospitals Foundation Trust Lancashire and South Cumbria
The Christie Foundation Trust Greater Manchester
The Clatterbridge Cancer Centre Foundation Trust Cheshire and Merseyside
Network 10  
Hull and East Yorkshire Hospitals Trust Humber, Coast and Vale
Leeds Teaching Hospitals Trust West Yorkshire
Sheffield Teaching Hospitals Foundation Trust South Yorkshire, Bassetlaw, North Derbyshire and Hardwick
Network 11  
North Cumbria University Hospitals Trust North East and Cumbria
South Tees Hospitals Foundation Trust  
The Newcastle Upon Tyne Hospitals Foundation Trust